Impact of COVID-19 on General Medical Rehabilitation Efficiency in Designated Inpatient Facilities: A Comparative Analysis of Patient Outcomes and Care Processes

Abstract

Objective

To evaluate how the COVID-19 pandemic affected rehabilitation outcomes and care delivery processes in Physical Medicine and Rehabilitation programs of COVID-19-designated rehabilitation facilities.

Design

Retrospective cohort study comparing care processes and outcomes between prepandemic and pandemic periods and identifying factors that influenced rehabilitation efficiency using the total score of the Functional Independence Measure (FIM) instrument.

Setting

Four designated subacute rehabilitation facilities.

Participants

Patients (N=507) from the Physical Medicine and Rehabilitation program (PMR), with a mean age of 78.3 years (range: 28-99y) and 60% women (ranging from 58% to 64% across groups). The cohort included prepandemic patients (33%), non-COVID-19 patients during the pandemic (33%), patients who were COVID-19-positive before admission (23%), and those who acquired COVID-19 during rehabilitation (11%).

Interventions

Not applicable.

Main Outcome Measures

Average daily gain in functional independence using the FIM total score (FIM efficiency), clinical and demographic profiles at admission, functional outcomes, and indicators of care delivery processes.

Results

While functional outcomes were mostly similar across groups (FIM total score at discharge, P≥.05), patients who acquired COVID-19 during rehabilitation experienced longer stays (mean difference=32.2d, P<.001) and higher rehospitalization rates (48%, P<.001). In contrast, those infected before admission had shorter stays (mean difference=−9.5d, P<.001) and less multidisciplinary involvement (mean difference=1 discipline, P<.001). Linear mixed effects modeling, with rehabilitation site as random effects, demonstrated that COVID-19 acquisition during rehabilitation and increased multidisciplinary care were significant predictors of reduced FIM efficiency (P<.001).

Conclusions

The COVID-19 pandemic affected rehabilitation care delivery processes more than functional outcomes. Patients who acquired COVID-19 during rehabilitation and those requiring more diverse multidisciplinary care showed reduced FIM efficiency, highlighting the importance of infection control measures in rehabilitation settings. These insights will help health care professionals and decision makers optimize future crisis preparedness plans for rehabilitation services.